Peace on Earth (and at the VA)

Get this... it is actually SLOW here at the VA, from where I start to write this blog. We thought it might start to slow down over the holidays and, in fact, we are having people want to jet left and right (hmmm... you think that people would want to be home and not in the hospital over Christmas??! I had a fairly whiny patient ask me if he could have a "pass" to be out of the hospital for Christmas and just come back whenever he felt like it afterwards to the same room. I said "I'll see what I can do" although I thought about saying, "WHY CAN'T I HAVE A PASS ?!") with few admissions to replace them. I am down to 3 (yes, THREE, which is the fewest I have had this month!) patients, which, let me tell you, is much more manageable than 7+ sick ones (LOTS fewer notes to write)!

I had been doing quite well (i.e. no breakdowns!) until yesterday, when I had a very difficult case to deal with, a wonderful elderly man with terminal prostate and bladder cancer with bleeding from his urine, but also with a cardiac stent less than a year old with risk of clotting and large pulmonary emboli that could kill him any minute. We all had to decide to anticoagulate him and risk bleeding him to death or leaving him as is, to die from either his cancer or clots in his lungs. There was no right answer in the situation, I was getting opposing opinions from cardiology and urology and felt totally incapacitated by the situation, as well as entirely moved by his condition, his attitude, and the grace of both him and his wife. I don't think the wife was too comforted by my bawling in the room as we talked about prognosis and code status, but I finally got it together. Will try to make it through the rest of the month w/o the waterworks. (What was quite funny, though, was that earlier in the morning, Dr. E., an attending I had during my first very stressful month at Mather but who was now with the other internal medicine team said to me, in apparent all seriousness, "Wow, Tara, you look so much happier this time around. Are you medicated??" :) Of course, this was before the breakdown). In any case, we hope the patient be able to go home tomorrow to spend Christmas with his family, at peace at the end of his life.

I found out today that I have tomorrow (Christmas eve) off. I'm still trying to get into the holiday spirit. Shomir and I saw Messiah at the Mondavi Center last night, which was great. But it is still weirding me out that it's like 50 degrees out! I busted out my collection of Christmas ornaments and some blue lights just last night, so my apt. is kind of festive, but it's just a bizarre kind of holiday season. Anika will take Tuesday off, so I'll be here, but I'm hoping to go to a Christmas eve service tomorrow night (anyone free?) and could potentially get out early on Christmas for my "half-day" off this week if it's slow. On Wednesday, the 26th, it's back to a regular workday, with clinic in the afternoon-- the hospital will probably be slammed with post-Christmas CHF exacerbations and whatnot. Who knows what is happening over New Year's. I'll probably find out the day before or something.

We were trying to figure out how to get some Christmas tunes playing on the computers in the resident work room here at Mather, but apparently the internet browsers are blocked from all kinds of audio-visual sites. Bummer! Otherwise, if I had my way, we'd all be singing aloud to carols here :).

Talked to my parents yesterday and apparently my sister is "home" (i.e. packed her bags to head home from Arlington across town to McLean!) for the holidays. It's weird not being there. Despite schlepping all over the place the last 8 years or so, I think I've been with my family (albeit not at "home"-- last year Mexico, the year before Egypt, etc.) for Christmas every year since college. Maybe I can call them from the VA on Tuesday :)

Anyway, it's quite peaceful here and I hope it stays that way until circa 7 p.m. when I'm off :) I may actually try to go lie down for a few minutes until I get paged, inevitably for having filled out something incorrectly :)

MERRY CHRISTMAS! PEACE ON EARTH!!!!